Nearly three million older persons are housed in long-term care (LTC) settings. Until recently, most resided in nursing homes (NHs), but residential care/assisted living (RC/AL) facilities have been proliferating as alternatives to NH care. RC/AL facilities are extremely varied, ranging from small board and care homes to large complexes. The residents they serve also are diverse, and many resemble persons in NHs, including elderly with Alzheimer's Disease and related dementias. Despite the prevalence of RC/AL, research data in this area are sparse. The principal investigator has conducted statewide studies of NH care, and is currently conducting the largest study of the structure and process of care across RC/AL facilities, with the aim of identifying facility characteristics that relate to resident outcomes. Her involvement in these projects focusing on the quality of life and quality of care in NHs and RC/AL settings position her to undertake the aims of the proposed project. The focus of the proposed research is on three areas that are especially relevant in this evolving field: (1) the relationship between RC/AL quality of care and regulation; (2) health care utilization and cost in RC/AL compared to NHs; and (3) the implementation and evaluation of LTC policy using an outcomes-based perspective. This independent scientist application outlines three sets of activities to enhance the candidate s ability to make scholarly contributions to the field of RC/AL: working with national policy and RC/AL experts to compare facility characteristics that relate to outcomes to those addressed in existing regulations, culminating in manuscripts and the development of a demonstration project; working with health policy and LTC experts and receiving additional training toward the development of manuscripts and a application to use Medicare data to better understand issues of utilization and cost across RC/AL and NHs; and working with state regulators and health services research and policy experts to develop measures and protocols to monitor the implementation and outcomes of new LTC policies. Overall, the principal investigator's ultimate objective is to improve the quality of LTC for our nation's elderly.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Scientist Development Award - Research (K02)
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Application #
Study Section
National Institute on Aging Initial Review Group (NIA)
Program Officer
Stahl, Sidney M
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University of North Carolina Chapel Hill
Internal Medicine/Medicine
Schools of Medicine
Chapel Hill
United States
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Daaleman, Timothy P (2012) A health services framework of spiritual care. J Nurs Manag 20:1021-8
Williams, Sharon W; Zimmerman, Sheryl; Williams, Christianna S (2012) Family caregiver involvement for long-term care residents at the end of life. J Gerontol B Psychol Sci Soc Sci 67:595-604
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Watson, Lea C; Zimmerman, Sheryl; Cohen, Lauren W et al. (2009) Practical depression screening in residential care/assisted living: five methods compared with gold standard diagnoses. Am J Geriatr Psychiatry 17:556-64
Daaleman, Timothy P; Williams, Christianna S; Preisser, John S et al. (2009) Advance care planning in nursing homes and assisted living communities. J Am Med Dir Assoc 10:243-51
Dobbs, Debra; Eckert, J Kevin; Rubinstein, Bob et al. (2008) An ethnographic study of stigma and ageism in residential care or assisted living. Gerontologist 48:517-26
Sloane, Philip D; Zimmerman, Sheryl; Williams, Christianna S et al. (2008) Dying with dementia in long-term care. Gerontologist 48:741-51
Williams, Sharon Wallace; Williams, Christianna S; Zimmerman, Sheryl et al. (2008) Emotional and physical health of informal caregivers of residents at the end of life: the role of social support. J Gerontol B Psychol Sci Soc Sci 63:S171-83

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